MANAGED CARE DEALS ARE CRITICAL TO KEEP SERVING MEDICAID PATIENTS

Betsey Kaufman believes the clients of Planned Parenthood of Greater Cleveland are exactly what managed care companies are looking for.
At least three managed care companies agree.
Planned Parenthood of Greater Cleveland and the 10 other Planned Parenthood affiliates statewide recently signed their first managed care contract with United Healthcare Corp. of Minneapolis. United Healthcare's Ohio organization has previously contracted with Planned Parenthood of Franklin County, but the contract represented the first time the Cleveland affiliate has been able to offer managed care to clients.
Following the United Healthcare contract, Planned Parenthood entered into contracts with the Health Payors Organization in Cleveland and Advance Plan, part of Community Mutual Insurance Co. of Cincinnati.
Ms. Kaufman said the organization is nearing a deal with Blue Cross & Blue Shield of Ohio.
It's all a part of a drive by Planned Parenthood and other reproductive health care providers to keep access to a Medicaid population that's rapidly moving into HMOs.
'Our relationship with Planned Parenthood is an extension of the state fee-for-services program,' said Dave Amerine, director of Medicaid programs for United Healthcare of Ohio. 'We (United Healthcare and Planned Parenthood) came together about the same time in an effort to provide family planning services for those clients enrolled in MedPlan,' the company's Medicaid HMO.
Currently, Cuyahoga County Medicaid-eligible residents enrolled in the state fee-for-service program may volunteer to select a managed care company. By July 1, enrollment in managed care organizations will be mandatory.
For Planned Parenthood to continue to serve Medicaid-eligible patients after July 1, it will need contracts with state-licensed HMOs.
United Healthcare serves more than 900,000 patients in Ohio. About 42,000 of those are enrolled in MedPlan, Mr. Amerine said.
Planned Parenthood clients enrolled in Medicaid, Aid to Families with Dependent Chi
ldren and Healthy Start will receive the benefit of primary care physicians, access to over-the-counter medications and coordinated health care through a private organization, Mr. Amerine said.
'This is a pretty big relationship and we're hoping for substantial growth over the next several years,' Mr. Amerine said. He noted the partnership was a chance to capitalize on the widespread clientele Planned Parenthood serves and to take advantage of the organization's experience in family planning.
Ms. Kaufman said Planned Parenthood has 55 centers in Ohio and more than 900 nationally. The Cleveland affiliate serves 14,000 clients each year, offering services such as contraception, gynecological exams and vasectomies.
'Basically, prevention is our business,' Ms. Kaufman said. 'We serve a need that is so basic, it will never go away.'
Providing services to patients enrolled in managed care programs isn't all that's new at Planned Parenthood of Greater Cleveland.
Ms. Kaufman said the group is broadening its reproductive care services. Among its expanded offerings are menopausal services such as breast exams, Pap smears and hormone replacement therapy; continued education to prevent teen pregnancies, including evening hours three days per week; screening for sexually transmitted diseases in men; and colposcopy and cryotherapy screenings for early cervical cancer detection.
The local affiliate is not, however, following the lead of some other affiliates that are providing primary health care services beyond the scope of reproductive care. Ms. Kaufman said about a quarter of the nation's Planned Parenthood affiliates have moved into offering a full-range of primary care services. Many of those affiliates are much larger than the Cleveland organization.
'Women's reproductive health has been our niche,' Ms. Kaufman said. 'This is our mission and it doesn't negate doing more. But we don't want to dilute what we do best.'
Among the local group's most controversi
al changes is its plan to provide first trimester abortions one day a week at the Planned Parenthood clinic in Bedford. None of the four clinics in Greater Cleveland have ever offered abortion services.
Planned Parenthood of Greater Cleveland is still sorting through the guidelines in a 33-page emergency ordinance Bedford City Council enacted last summer when the affiliate unveiled its plan.
Bedford city manager Vilas Gamble said the ordinance sets guidelines for equipment, parking and operation of the clinic.
'While we cannot prohibit (abortions), we are allowed to regulate them and that's what we've done,' Mr. Gamble said.
Most of Planned Parenthood's expanded services offered are possible because of substantial local donations.
In 1995, 6% of the local chapter's $2.35 million budget came from federal Title X money, the part of the Public Health Services Act which funds family planning clinics. About 4% came from reimbursement from Medicaid.
The bulk of the remaining portion of the budget comes from patient fees and private donations, Ms. Kaufman said.